Fluoroquinolone-induced liver injury and pharmacists' interventions in pneumonia: a case report and clinical pharmacist intervention.

Abstract

Background The diagnosis of drug-induced liver injury (DILI) is difficult due to insufficient awareness of DILI and the lack of specific objective diagnostic tests. The importance of pharmacists' care during hospitalization is underestimated. Our aim is to review the clinical features of fluoroquinolone-induced liver injury and to highlight the importance of pharmacists' intervention in fluoroquinolone-induced liver injury. . Case presentation: An 81-year-old Chinese man was admitted to hospital for the treatment of community-acquired pneumonia. After admission, he developed chronic subdural hematoma as his condition deteriorated, followed by intracranial infection after the cranial trepanation. On day 15, the patient still presented with fever and altered consciousness. Moxifloxacin (IV, 400 mg QD) was administered as the pulmonary infection became worse. Elevated liver enzymes were then observed with alanine aminotransferase (ALT) rising from 27 U/L to 387 U/L after the three-day use of moxifloxacin. With the help of pharmacists' interventions, drug-induced liver injury was identified. Moxifloxacin was discontinued immediately and replaced with meropenem (IV, 1g, Q8h). Within another 7 days, the patient's fever subsided, liver function normalized, and consciousness improved. He was successfully discharged from the hospital 30 days after admission. Written informed consent was obtained from the patient. Ethics approval was waived by the Institutional Review Board of Taikang Tongji (Wuhan) Hospital. Conclusions: Fluoroquinolone-induced liver injury are rare but can be lethal. Pharmacists' interventions enable collaborative decision-making and can help improve the management in fluoroquinolone-induced liver injury.